Complaining about current conditions or worse ones in the pipeline gets tiresome sometimes—nobody really wants to be Debbie Downer. So I’m glad to let you know of a bill in the works for Alabama this year with bipartisan support that could not only actually pass but also truly be a good deed.
CBD oil, cannabidiol oil, is a natural derivative of marijuana with minimal amounts of THC (the part that makes people high). Although there is not enough THC in the oil to be psychoactive, just the tiny amount present makes the product illegal in our state. Google CBD oil and you’ll pull up rave reviews for treatment of just about everything under the sun. I’m generally suspicious of panaceas—cure-alls, good for what ails you miracle drugs, generally turn out to be fads that get dropped when, surprise, they don’t actually cure it all. I wrote that last line before I found this article with a good description of the endocannabinoid system using almost the same words—by a physician in favor of medical marijuana.
Not all the purported benefits of CBD oil have been seriously studied, but some have. It turns out the research is compelling in animal models of epilepsy. CBD oil has shown strong anti-seizure effects for generalized, partial and temporal lobe epilepsy. We don’t have that level of data for human use, just a few small studies in adults. For children, we do have multiple anecdotal reports of patients with intractable seizures, who didn’t respond to any other treatment, using CBD oil with good results. Some of the stories are enough to make me catch my breath– children with Dravet Syndrome, suffering years of daily prolonged seizures and associated developmental regression, becoming not only completely seizure free or close to it but also showing reversal of their brain damage.
There is one published survey, from Stanford, of 19 parents who tried CBD oil for their children with epilepsy, including Dravet Syndrome. Sixteen of them, 84%, reported fewer seizures, most with 80% reduction or more. The three who didn’t respond did not get worse. The only side effects reported were drowsiness (37%) or fatigue (16%). The authors point out that common side effects of prescription seizure medication—rash (sometimes life-threatening), vomiting, irritability, dizziness, confusion and aggressive behavior did not happen with any of the children.
Animal studies have also not uncovered serious adverse reactions. One paper noted a shift in cytokine production by human cell cultures exposed to CBD, which could be helpful for autoimmune and inflammatory illnesses but might be harmful in chronic infections like HIV. We don’t have good quality clinical data on this question—Cochrane Reviews could not come to a conclusion about long term effects of marijuana or derivatives in HIV outcomes, for good or ill.
The way to find out if CBD will live up to these early reports? More well designed trials, and larger ones. We need to know if there are side effects that didn’t show up in the smaller groups, the best dosing regimens, and who is most likely to benefit. We need access to oil that will have a reliable concentration of CBD. The FDA has approved sites to study a specific, reliable concentration CBD oil in children, and 7 additional sites will be given IND (Investigational New Drug) approval for compassionate use.
Now I’m at the exciting part. Alabama may be getting one of those compassionate use approvals. I spoke to a respected pediatric neurologist who would be heading the program if done here. She has high hopes that the CBD oil may prove its worth. She told me it was very important for children to be able to get CBD oil with a known percentage of active ingredient and low THC, because parents had reported inconsistent results from one batch of oil to another with non-standardized products. The problem is that it is illegal in Alabama, standard or not. So parents in the FDA approved program would risk arrest – unless we pass a law to protect them.
The bill doesn’t recommend CBD oil use—both versions are going through their respective Judiciary Committees, not Health. Sure, they leave other ground untouched, like medical marijuana in general or even recreational marijuana. I think it would be inhumane for legal marijuana advocates to ask these children to wait until more comprehensive legislation has a chance. An exhaustive evidence base is not necessary. All we need to do is say CBD oil has no reason to be illegal. I could walk down any drugstore aisle in Alabama, close my eyes, spin around and point my finger, and I’d put money in advance that whatever I’m pointing at would have more known side effects.
When I first spoke to Mike Ball, the House sponsor, he was concerned he might meet opposition from those who are just going to say no to anything remotely related to marijuana. He said it was probably risky to sponsor the bill during an election year, but that after meeting the parents who are begging for help, he had to take the chance. He told me this hill was worth dying on.
I’m a skeptic about politicians, just like panaceas, and I tend to distrust their motives more often than not. Even though Mike and I don’t see certain critical issues the same way, I believe he is an honest man, and I believe he sincerely had his heart touched by these children and their parents. I’m impressed that he was willing to take a political risk for a good deed.
Since we talked, I’m seeing reports that the bill may not meet the opposition he anticipated—that’s good news, and all the more reason for us to pile on. First, we want to be darn sure it passes. Second, we don’t always have to pick only the iffy bills to champion. Sometimes, it might just be good to show an overwhelming support, across partisan lines, for a worthwhile goal. Sometimes, we can all get to be the home team. If you agree with me, please take this opportunity to contact your legislators. No matter what happens in the 2014 midterms or in 2016, we are going to need to find a way to get things done together in Alabama, and maybe it starts with something this simple and sweet.